REVISED CAROL ACT II

Project Summary Patients with valvular heart disease (VHD) requiring surgical intervention are at a high risk of adverse events. Notably, in the days following surgery, post-operative delirium is common, extends hospitalization, and may lead to long-term cognitive decline. These surgical patients are also at high risk for atrial and ventricular arrhythmias during and after hospitalization, although knowledge about the time course and burden of arrhythmias in the post-hospital setting is limited. Over time, the Cardiothoracic Surgical Trials Network (CTSN) has developed a unique platform of research in VHD that includes cutting-edge trials in patients with functional and degenerative mitral regurgitation, including mitral valve prolapse, as well as aortic stenosis and tricuspid valve disease. In this application, the Network proposes to build on this research agenda in several ways. First, we plan to incorporate rhythm monitoring into the soon to be launched EPIC trial, which evaluates the impact of left posterior pericardiotomy on preventing POAF during hospitalization (